What are hot flushes?

  • A hot flush (USA - hot flash) is a sudden temporary symptom of heat experienced by the majority of women around the time of their menopause.
  • The symptom is due to dilatation of the blood vessels in the skin - it is known as a vasomotor event.
  • Hot flushes and night sweats are the most common symptoms associated with the menopause.
  • One woman in five will have hot flushes associated with the menopause..
  • Many women have problems with hot flushes and night sweats for just a few months, but these troublesome symptoms can persist for a number of years.
  • Hot flushes are not caused by a lack of oestrogen, but by a sudden drop in oestrogen. This is why hot flushes usually stop once the level of oestrogen stabilises.
  • Hot flushes may be initiated by blankets, hot-water bottles, coffee, tea and spicy foods... Hot flushes can involve the neck and face, upper arms, or the entire body. They may last a few seconds only or a few minutes and they can be mild or strong. Increased blood flow to the area raises the skin temperature and this creates a flush - red and blotchy skin. Sweating is the body's natural way of trying to cool down.
  • Affected women may be premenopausal or postmenopausal.
  • Hot flushes can be particularly distressing for women reaching their menopause before the age of forty - premature menopause.

What causes hot flushes and night sweats?

At the menopause the ovaries have become depleted of eggs - ovarian failure. The cause of hot flushes (flashes) seems to be a response to a fall in the main female hormone - estrogen and the resulting deficiency on the blood vessels in the skin which dilate resulting in increased local blood flow.

A decline in oestrogen leads to alterations in brain neurotransmitters (chemicals) and to instability in the hypothalamic thermoregulatory settings.

Hot flushes are frequently associated with other menopausal symptoms such as vaginal dryness, labile moods, headaches, bladder problems and reduced libido.

night sweats (sleep hyperhidrosis)

  • Night sweats is the occurrence of excessive sweating (hyperhidrosis) during sleep.
  • NIght sweats may occur at any age, but is most commonly seen in early adulthood.
  • Night sweats can be even more upsetting than daytime flushes because they disrupt sleep leading to daytime fatigue, poor memory and tension.
  • They can be hereditary and may be relatively harmless.
  • The most common causes of night sweats in women over 40 is the hormonal changes related to menopause and perimenopause. This is a very common occurrence around the menopause years. It is not dangerous or a sign of underlying disease. Some women experience night sweats during pregnancy.
  • While most causes of night sweats may be relatively harmless, others may not and can be a sign of a serious underlying disease such as infections, endocarditis, hyperthyroidism, HIV, TB and non-Hodgkins Lymphomas. True night sweats with medical causes should be properly investigated by a medical physician.

Treatment of Hot Flushes and night sweats

Hot flushes and night sweats are the amongst the most common gynaecological symptoms requiring medical advice and treatments at the menopause.

If there are night sweats, symptoms should not automatically be attributed to the menopause without consideration of other causes.

There are many options for treating hot flushes and night sweats ranging from lifestyle changes to prescription medications.

For mild hot flushes: Start with diet and lifestyle changes

  • Keep yourself cool. Dress in layers so that you can remove clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing
  • Watch what you eat and drink. Hot and spicy foods, caffeinated beverages and alcohol can trigger hot flushes. Learn to recognize your personal triggers and avoid them.
  • Stop smoking. Smoking is linked to increased hot flushes.

Complementary or Alternative Medicine Treatments.

A number of complimentary remedies have been promoted ranging from Chinese herbal remedies, dietary supplements to acupuncture. There are many unlicensed complementary therapies available for menopausal symptoms, but there is no evidence based studies demonstrating that any of them are effective. They may contain products such as soy, red clover, black cohosh and ginseng, can be potentially harmful. Phytoestrogens belong to a large group of  compounds known as flavonoids: the isoflavones are three of the most active in estrogenic effects in this class. The best known are soy and red clover.

There is minimal control over the quality of  complementary therapies, and their long-term safety has not been determined. They may have unpleasant side effects and can interfere with other medications.

  • Black cohosh. Black cohosh has been used widely in Europe for treating hot flushes and is becoming increasingly popular among women with menopausal symptoms in the United States. While its safety record has been good, scientific appraisal has not confirmed its efficacy for hot flushes or night sweat relief.0801

Prescription medication options

If you continue to have troublesome hot flushes your doctor may recommend hormone therapy.

Hormone Replacement Therapy and Hot flushes

Estrogen replacement therapy is the most effective treatment for hot flushes.

HRT has been available for more than fifty years. Most of the early preparations were of equine origin - conjugated oestrogens - Premarin. More modern HRT preparations are produced from plants, notably the Mexican yam.

We need to consider the risks and benefits of HRT. There has, unfortunately, been conflicting information about HRT. For example, a large WHI study initially claimed that HRT would have an adverse effect on the heart but they subsequently showed that it may be beneficial for women in their fifties.

There are many choices of HRT preparations.

If the uterus is present, a progestogen (similar to progesterone) must be included to prevent thickening of the lining of the uterus (endometrial hyperplasia) as this can rarely lead to endometrial cancer. Women who have taken the combined HRT are even less likely to develop endometrial cancer than those who have never taken HRT. HRT is available as tablets, skin patches and sub-dermal implants. At one time, HRT with progestogens was only given on a cyclical basis so that there were monthly bleeds like menstruation. Tibolone (Livial) was the first preparation to provide a continuous bleed-free option for postmenopausal women. There is now a choice of several oral and transdermal patches for continuous combined administration.

If you have had a hysterectomy , then oestrogen alone is indicated.

The menopause is associated with long-term health risks particularly bone thinning (osteoporosis) and coronary heart disease. HRT has a part to play in the prevention of these conditions.

The main concern with HRT is a slight increased risk of breast cancer although this is probably not of significance if it is taken for less than five years.

Many women with a history of breast cancer take tamoxifen. This has both anti-oestrogenic and oestrogenic effects. The anti-oestrogenic activity reduces recurrence and many find that it reduces hot flushes.

Progesterone cream has been advocated as a treatment for hot flushes but it has not been proven in randomized placebo controlled trials.


Low doses of certain antidepressants may decrease hot flushes. Antidepressants from classes of medications known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have been found to relieve hot flushes in some clinical trials. These include venlafaxine (Effexor), paroxetine (Paxil), fluoxetine (Prozac), citalopram and (Celexa).

Many doctors now consider these antidepressants the treatment of choice if you have troublesome hot flushes and can't €" or choose not to €" take hormone therapy. However, these medications aren't as effective as hormone therapy for severe hot flushes and may cause unwanted side effects, such as nausea, dizziness, weight gain or sexual dysfunction. Talk with your doctor about whether the benefits outweigh the potential side effects for you.

Clonidine, a pill or patch used to treat high blood pressure, may provide some relief from hot flushes. Side effects such as dizziness, drowsiness, dry mouth and constipation can occur.

Women's Health

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Women's Health

This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

Answers to FAQs on women's health, patient information and medical advice by David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist (Gynecologist - OBGYN), Department of Obstetrics and Gynaecology,

The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - www.2womenshealth.com - to provide detailed
information many of his patients requested. The website attracts thousands of visitors every day from around the world.
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